Medicaid, Obamacare big issues

The irony was heavy at the Capital Club’s penthouse suite as journalists and legislators ate, drank, relaxed and discussed the great issues of the day.

The big issue was Medicaid, possibly a billion dollars extra a year in money coming into the state as part of Obamacare. Huge money for a poor state that has always taken in two to three times the amount it pays in federal taxes. Big time federal largesse.

The irony? The legislative bigwigs are conservative Republicans who detest the rapid expansion of our welfare state. They also detest the loss of state power to federal bureaucrats.

But a billion dollars is a billion dollars. Ten billion over the next 10 years. It’s hard to turn that kind of money down.

Further irony: Mississippi is the poorest state in the nation (money wise). Yet it is the most conservative, based on presidential election results. How can this be? How can the state most dependent on federal subsidies be the state most fiercely biting the hand that feeds it? What’s going on here?

I have a couple of ideas. First of all, our lower per capita income is related to the rural nature of Mississippi. Rural areas tend to be more conservative, more reliant on individual initiative and more skeptical of federal bureaucrats.

It’s not that we’re conservative because we’re poor. It’s that we’re poor because we’re less urbanized. Urbanization and left-wing politics seem to go hand in hand, as the red state - blue state divide illustrates.
Less urbanization means less big business and more small business. Big business leads to big profits, but also big unions and class conflict between management and labor. These types of class divisions aren’t significant in small towns and small businesses where individual effort and personal interactions rule the day.

The Republican values of personal initiative, hard work and self-reliance resonate more clearly in a small-town environment than a mega city. Thus the irony. We need the money but we don’t like its effects.
Small-town life can be revealing. We know each other. We interact with each other. Less is hidden. There is little anonymity.

That means the disincentives caused by the welfare state are more readily apparent. This causes resentment as taxpayers see their tax dollars being redistributed to their neighbors who may be more willing to accept government welfare.

When the state legislative Republicans were out of power, it was easier. They could rant and rave about the welfare state, while the Democratic majority made sure the federal money kept flowing.

But things have changed, the Republicans now control the state Legislature. After decades of being back-benchers, they are in charge. They fully have the power to say no to the billion dollars a year in Medicaid money. What will they do? They don’t know yet.

Or so say the Republican leadership assembled that night: speaker Phil Gunn from Clinton, appropriations chairman Herb Frierson from Poplarville, speaker pro tempore Greg Snowden from Meridian, and several other key legislative leaders.

George Flaggs, corrections chairman and a Democrat, has survived the changing of the guard and has made his peace with the Republican leadership. His point of view was clear as a bell: We’d be out of our minds to leave this kind of money on the table. Medical care is a huge economic driver in our state. For the first three years, the feds are promising to pay 100 percent of the costs. Then pay 90 percent until 2020. Money for nothing!

Not everybody believes these wonderful promises of federal money. The federal government is broke. If interest rates go up, the feds will have their hands tied. What will happen then? Likely, the feds will cut Medicaid funding and tell the states it’s their problem.

This would leave Mississippi high and dry with hundreds of thousands of new Medicaid recipients used to free medical care. A political firestorm would result.

These are not small numbers. The proposed Obamacare expansion of Medicaid could add from 250,000 to 400,000 new recipients. A third of the entire state may be getting free medical care. The cost to the state could be in the billions over time.

It’s a huge issue involving a huge amount of money and a huge benefit. Already, 28 states have shown their distaste for Obamacare by joining in a lawsuit that went to the Supreme Court. The Supreme Court didn’t nullify Obamacare, but they did give states the right to say no to the Medicaid expansion. Thus the dilemma for our new legislative leaders.

Gov. Phil Bryant has made it clear he will resist the Medicaid expansion. Gunn, Snowden and Frierson were non-committal. Their main point: There’s no sense in trying to grapple with this issue until after the presidential election. If Romney is elected and the Republicans take the U.S. Senate, Obamacare will be repealed and it’s a moot issue. You can bet your bottom dollar that’s what they are hoping for.

But if Obama is re-elected, it will be crunch time for the new Republican House leadership. Will they really have the guts to turn away billions of dollars in federal money, money that would flow into every hospital, doctor’s office and town in the state of Mississippi?

That’s the problem with being in power. It’s your decision. There’s no one else to blame.